Pediatric Heart Transplant Program, Department of Pediatrics, School of Medicine, University of Pennsylvania, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
J Heart Lung Transplant. 2009 Dec;28(12):1273-8. doi: 10.1016/j.healun.2009.07.020. Epub 2009 Sep 26.
Body mass index (BMI) both before and after heart transplant (HT) is used to risk stratify in adult HT. Single-center studies identify BMI as a potential predictor of outcome after HT in children; large-scale analyses in pediatric HT have not been performed.
The ISHLT pediatric heart transplant registry was queried for HT recipients >2 years old between 1996 and 2006 with data for BMI percentile (BMI%ile) at HT. Survival and morbidity rates post-HT were compared between BMI%ile cohorts defined as: wasted, <5th BMI%ile; normal, 5th to 95th BMI%ile; and obese, >95th BMI%ile at HT.
Data from 2,333 pediatric HT patients were available for analysis. Incidence of abnormal BMI%ile at HT was: wasted = 23% and obese = 8%. Wasting and obesity were similar in patients with congenital or cardiomyopathic diagnoses. Wasted or obese patients at HT did not differ from patients with normal BMI in survival on Kaplan-Meier or multivariate analyses. There were no significant differences in pre-, peri- or post-operative adverse events between patients with wasting or obesity and those with normal BMI%ile at HT.
In contrast to adults, abnormal body mass at time of transplant was not associated with decreased survival in pediatric HT recipients. Potential pediatric transplant candidates should not be excluded based on the perception that wasting or obesity will increase the risk of adverse outcomes.
体重指数（BMI）在心脏移植（HT）前后都被用于成人 HT 中的风险分层。单中心研究表明 BMI 是儿童 HT 后结局的潜在预测指标；但尚未在儿科 HT 中进行大规模分析。
查询了 1996 年至 2006 年间年龄大于 2 岁的接受 HT 的 ISHLT 儿科心脏移植登记处，获取 HT 时 BMI 百分位数（BMI%ile）的数据。将 HT 时 BMI%ile 定义为：消瘦，<第 5 个 BMI%ile；正常，第 5 个至第 95 个 BMI%ile；肥胖，>第 95 个 BMI%ile，比较 HT 后生存和发病率的 BMI%ile 队列之间的差异。
共有 2333 名儿科 HT 患者的数据可用于分析。HT 时异常 BMI%ile 的发生率为：消瘦=23%和肥胖=8%。在先天性或心肌病诊断的患者中，消瘦和肥胖的发生率相似。在 Kaplan-Meier 或多变量分析中，HT 时消瘦或肥胖的患者与 BMI 正常的患者在生存方面没有差异。在 HT 时消瘦或肥胖的患者与 BMI 正常的患者相比，在术前、围手术期或术后不良事件方面没有显著差异。
与成人不同，移植时异常的体重与儿科 HT 受者的生存率降低无关。潜在的儿科移植候选人不应因消瘦或肥胖会增加不良结局的风险而被排除在外。
